Voiding and sexual dysfunctions after pelvic fracture urethral injuries treated with either initial cystostomy and delayed urethroplasty or immediateprimary urethral realignment

Objective: The aim of this study is to evaluate the effects of the differen t immediate treatment modalities on the sexual and voiding functions in pel vic fracture urethral injuries. Methods: The records of 38 male patients wi th traumatic posterior urethral injuries were reviewed, 18 of whom were tre ated by initial suprapubic cystostomy and delayed repair (Group 1), and 20 by primary urethral realignment (Group 2). Types of pelvic fractures and ur ethral injuries were classified according to surgical and radiological find ings. Long-term voiding functions were determined by the patient questionna ire, residual urine and uroflow. Sexual functions were also determined by t he patient questionnaire and a penile duplex ultrasound study. Results: Mea n follow-ups of Groups 1 and 2 were 37 and 39 months, respectively. Membran ous urethral disruption extending to the urogenital diaphragm was the most frequent urethral injury (type 3), with incidences of 66.7% and 77.7%, resp ectively. There were no statistically significant differences in mean age, incidence of pelvic fi fracture types and urethral injury types between gro ups (p > 0.05). After the immediate treatments, 16.7% and 55% of the patien ts regained normal urination, and stricture developed in 83.3% and 45% of t he patients, respectively. In 44.4% of the patients in Group 1 and 10% in G roup 2, urethral strictures required open urethroplasty (p<0.05). Erectile impotence before urethloplasty in 17.6% and 20%, anejaculation after urethr oplasty in 17.6% and 15% and incontinence in 5.6% and 10% of the patients w ere found in Groups I and 3,, respectively (p > 0.05). However, 88.8% and 9 0% of patients eventually achieved normal urination with complete continenc e. Conclusion Sexual and voiding dysfunction after pelvic fracture posterio r urethral injury seem to be the result of the injury itself, nor of the im mediate treatment modalities. In urethral disruption injuries, primary uret hral realignment seems more favourable than suprapubic cystostomy and delay ed repair.